Comparative study of continuous surgical transverse abdominis plane block versus intravenous fentanyl infusion for postoperative pain management in open nephrectomy

Abstract

Background: Role of continuous infusion of local anesthetic drug in the transverse abdominal plane using a catheter inserted during the surgical closure of the wound has not been evaluated as a “sole technique” in patients undergoing open nephrectomy. Thus we designed this prospective, randomized comparative study to evaluate this aspect. Aim and Objectives: To compare the efficacy of continuous surgical transverse abdominal plane block with intravenous fentanyl infusion in open nephrectomies. The primary outcomes were post-operative tramadol consumption, pain at rest and pain while coughing. The secondary outcomes were the level of sedation, time to mobilize, and the incidence of wound infection. Material and Methods: Fifty patients undergoing elective open nephrectomy were randomly divided into two equal groups to either receive intravenous fentanyl infusion (Group A), or continuous infusion of bupivacaine in the transversus abdominis plane through a surgically inserted catheter (Group B). The independent sample t-test was applied for numerical variables, while one way Analysis of Variance (ANOVA) repeated measure was used for analyzing the continuous variables. Chi-square and Fisher's exact tests were the tools used for analyzing the dichotomical variables. Results: Tramadol consumption, pain while resting, and pain during coughing were significantly lower in Group B (p<0.001, p=0.003, p=0.001 respectively). Level of sedation and time to mobilize were also significantly lower in patients of Group B. Adverse effects were not differing significantly between groups. No wound infection was noted in either group. Conclusion: Continuous surgical wound infusion of 0.25% bupivacaine through a catheter placed by the surgeon in the transverse abdominal plane in open nephrectomy patients can be considered as an effective and safe alternative of providing postoperative pain relief than intravenous fentanyl infusion.

Keywords

• surgical transverse abdominal plane block
• open nephrectomy
• fentanyl infusion
• pain relief
• sedation score